Citation Nr: 21008421 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 15-10 787 DATE: February 22, 2021 ORDER Entitlement to service connection for degenerative arthritis of the left thumb is granted. REMANDED Entitlement to a rating in excess of 10 percent for service-connected left wrist De Quervain’s tendonitis, status post tenosynovectomy, is remanded. FINDING OF FACT The Veteran’s arthritis of the left thumb is proximately due to her service-connected left wrist De Quervain’s tendonitis. CONCLUSION OF LAW The criteria for service connection for degenerative arthritis of the left thumb as secondary to a service-connected left wrist De Quervain’s tendonitis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from February 1979 to August 1992. The Veteran testified before the undersigned Veterans Law Judge in a May 2018 Video Conference Board Hearing. A transcript of that hearing is of record. 1. Entitlement to Service Connection for Degenerative Arthritis in the Left Thumb To establish service connection on a secondary basis, there must be (1) medical evidence of a current disability; (2) a service-connected disability; and (3) medical evidence of a nexus between the current disorder and service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). The first two requirements of secondary service connection are met. A July 2019 VA examination and associated June 2019 X-ray examination shows degenerative arthritis of the left thumb. The Veteran is also service connected for left wrist De Quervain’s tendonitis, status post tenosynovectomy, rated as 10 percent disabling. The evidence is ambivalent regarding the third element requiring an etiological relationship between the Veteran’s service-connected left wrist disability and arthritis of the left thumb. The examiner responsible for the July 2019 VA examination concluded that the Veteran’s service-connected left wrist disability did not cause or aggravate the Veteran’s left thumb degenerative arthritis. According to the examiner, the Veteran’s 2014 surgery should not have affected her metacarpophalangeal joints. The examination report also attributes the Veteran’s arthritis to age, wear and tear, and trauma other than the 2014 surgery. However, the discussion of the Veteran’s surgery in the July 2019 VA examination report indicates that her left thumb was indeed involved and that she experienced left thumb symptoms following it. According to the examination report, pain onset in the Veteran’s left thumb in 1982, and she was diagnosed with De Quervain’s of the left thumb in 1982. She used splints and braces to manage her symptoms until undergoing surgery in 2014. While there was some improvement in her symptoms following the 2014 surgery, the examination report states that she developed left wrist and left thumb pain. The examination report also shows that the Veteran has developed reduced range of motion in her left thumb and difficulty grasping objects in her left hand following the surgery. The Board also notes that the July 2019 VA examination report assessing the severity of her left wrist disability diagnosed her left wrist disability as De Quervain’s Tendonitis in the Left Wrist, Status Post Tenosynovectomy Left Thumb/Wrist. In light of the foregoing, the Board concludes that the July 2019 VA examinations for the Veteran’s left wrist and thumb establish a nexus between her service-connected left wrist disability and her left thumb degenerative arthritis. The Board notes the negative nexus opinions; however, the discussion of the Veteran’s medical history and the surgery performed in 2014 is inconsistent with the rationales for those opinions. This inconsistency undermines the probative weight of the nexus opinions. The discussion of the surgery as involving the Veteran’s left thumb is more probative than the negative nexus opinions. Accordingly, service connection for degenerative arthritis of the left thumb is granted. REASONS FOR REMAND 1. Entitlement to a Rating in Excess of 10 percent for Service-Connected Dequervain’s Tendonitis, Status Post Tenosynovectomy In light of the decision granting service connection for arthritis of the left thumb, the Board concludes that the Veteran’s claim for a rating in excess of 10 percent for her service-connected left wrist disability must be remanded. In her hearing testimony, the Veteran indicated that she cannot differentiate between symptoms in her left wrist and symptoms in her left thumb. The July 2019 VA examination for the Veteran’s left thumb disability noted that the symptoms from her left wrist and her left thumb cannot be differentiated. Seeing as service connection for the left thumb disability was granted herein and a rating has not yet been assigned for this disability, the overlapping symptoms preclude the Board from adjudicating the Veteran’s claim for an increased rating for her left wrist disability. Because her rating for her left wrist disability is inextricably intertwined with the Veteran’s yet-to-be-assigned rating for the left thumb disability for which service connection was granted herein, the claim must be remanded. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The matter is REMANDED for the following action: Adjudicate the Veteran’s claim for a rating in excess of 10 percent for a left wrist disability after assigning a rating for her now service-connected left thumb disability. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Douglas M. Humphrey, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.